Abstract:
BACKGROUND:Palliative care is an important and necessary humanistic facet of ICU care. Wide variations exist in selection and implementation of palliative care decisions. Understanding patient factors associated with these decisions is crucial. STUDY DESIGN:Consecutive deaths (n = 151 patients) in a tertiary care surgical ICU during a 2-year period were reviewed. All data had been entered into the APACHE IV database. Patients were divided into groups: Withhold (WH), which included patients who had potentially lifesaving therapies withheld or withdrawn, and Full Care (FC), which included patients who had full resuscitative efforts before death. Patient factors including demographics, severity of illness, admission source, and history were compared between groups. RESULTS:Of 151 patients, 111 (74%) had potentially lifesaving therapy withheld or withdrawn (WH group). Forty patients (26%) had full treatment, including CPR, until time of death (FC group). Compared with WH, FC patients had a higher degree of illness at ICU admission (APACHE IV score 103.4 ± 36.6 vs 90.6 ± 29.3; p < 0.02) and were less likely to be male (35% vs 62%; p < 0.005). There were no differences between groups with regard to age, requirement for intubation on admission, medical history, admission source (emergency room vs operating room vs recovery room) or the number of patients admitted status post emergent vs elective surgery or admitted for nonsurgical diagnoses. In a multivariable regression model, male sex (odds ratio = 3.22; 95% CI, 1.45-7.19) and severity of illness (odds ratio = 0.98; 95% CI, 0.97-0.99) retained independent associations with decisions to limit care. CONCLUSIONS:Higher severity of illness and history play no role in the decision to limit care. Sex plays a strong and independent role. Factors influencing end-of-life care require additional study.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Lissauer ME,Naranjo LS,Kirchoffner J,Scalea TM,Johnson SBdoi
10.1016/j.jamcollsurg.2011.09.003subject
Has Abstractpub_date
2011-12-01 00:00:00pages
766-70issue
6eissn
1072-7515issn
1879-1190pii
S1072-7515(11)01054-4journal_volume
213pub_type
杂志文章abstract:BACKGROUND:Recent literature suggests that focus in health care should shift from reducing costs to improving quality; where quality of health care improves, cost reduction will follow. Our primary aim was to investigate whether improving the quality of surgical colorectal cancer care, by using a national quality impro...
journal_title:Journal of the American College of Surgeons
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abstract:BACKGROUND:Cecal leak or disruption after appendectomy for complicated appendicitis is a consequence of severity of disease and is related to residual abscess cavity, inflammation, phlegmon, and nonviable intestine. In an attempt to improve results, we have begun to resect the cecum and other localized infected tissue ...
journal_title:Journal of the American College of Surgeons
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更新日期:1994-08-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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